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The Belle Glade medical center’s auditor blamed several outside factors for the mounting losses, including cuts to Medicaid reimbursements, salaries and repairs.

But a key problem has been the district’s continuing difficulty issuing patient bills. It’s a problem that’s hitting taxpayers in the wallet.

The taxpayer subsidy required to keep the hospital afloat surged from $5.6 million in 2012 to $7.6 million in 2013, the draft audit shows.

Bad debts were a huge problem, surging from $12 million in 2012 to $15 million in 2013. Charity care was more than $3.3 million. A reflection of the grinding unemployment and continued economic difficulties in the Glades? Certainly. But the auditor found four significant deficiencies that represent management failures.

First, it sampled 25 insured patients’ bills, and found that the insurers had not paid the district the contracted amount in six cases.

“The hospital was not paid the correct contract rates, and may be losing significant revenue to which it is entitled,” the auditor found.

Next, it found that the hospital and district administration used two totally different accounting software programs, and ended up with drastically different reports.

Third, it found business office errors in how financial information was being recorded. Fourth, the auditor found errors in how accounting estimates were made for Medicaid contractual allowances.

Perhaps worst of all, the auditor found the district employed a single coder for most of the year, while the normal staffing for a hospital of its size should have been three people.

“The bills are past due when the hospital sends them out,” the auditor reported.

Management responded that the Health Care District had tried to hire a coder, but “had no applicants respond.”

“Some of the coding problems related more to a lack of organization in the department rather than the coders themselves being backlogged,” the district replied.

In September, the district said, it brought on an additional coder and is in the process of hiring a medical records manager, a position vacant since 2011.

The district’s Audit and Compliance Committee meets to discuss the findings on Wednesday at 10 a.m. at the district’s Aeormedical Hangar, 4255 Southern Boulevard, West Palm Beach.